Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail.
10.12200/j.issn.1003-0034.2023.12.016
- VernacularTitle:附加锁定钢板并植骨治疗保留髓内钉的下肢长骨干骨折不愈合
- Author:
Sheng-Rui WANG
1
;
Jin-Yang YU
2
;
Yu-Hao WANG
1
;
Pei-Zhao WANG
2
;
Hong-Lue TAN
2
Author Information
1. Henan Univesity of Chinese Medicne Zhengzhou 450046, Henan, China.
2. Knee surgery Center, Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopedic Hospital, Luoyang 471002, Henan, China.
- Publication Type:Journal Article
- Keywords:
Intramedullary nail;
Bone graft;
Bone nonunion;
Femoral shaft;
Locking plate;
Tibial shaft
- MeSH:
Male;
Female;
Humans;
Adult;
Middle Aged;
Bone Transplantation;
Retrospective Studies;
Bone Plates;
Fracture Fixation, Intramedullary/adverse effects*;
Femoral Fractures/complications*;
Lower Extremity;
Fractures, Ununited/surgery*;
Fracture Healing;
Tibial Fractures/complications*;
Bone Nails;
Treatment Outcome
- From:
China Journal of Orthopaedics and Traumatology
2023;36(12):1191-1195
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.
METHODS:A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.
RESULTS:All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).
CONCLUSION:On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.
